A Preliminary Study Of The Occurrence Of Fetal Distress And The Change Of Umbilical Cord,the Change Of The Expression Of Vasoactive Substance In Umbilical Vein In Intrehepatic Cholestasis Of Pregnancy

Objective To investigate the change of umbilical cord and thevasoactive substance in umbilical vein in intrehepatic cholestasis ofpregnancy.Methods Use HE staining method to analyze the patho- change ofumbilical cord of 25 ICP with fetal distress group, 25 ICP with out fetaldistress group, 26 normal pregancies with fetal distress and 27 normalpregnancies with out fetal distress(control group); the NOS/ET-1 weredetected in HUVEC of those four groups by immunohistochemistrymethod, Analyze the dependability between umbilical vein TBA andNOS/ET-1, use Griess method to detect metabolic product of NO(NO₂^-)in umbilical vein, and use radioimmunoassay method to detectET-1 in umbilical vein.Result1,There is remarkable high TBA level was found in umbilical veinin ICP, and the ICP with fetal distress group(19.02±2.32μmol/L) is higherthan ICP without fetal distress group (9.02±1.73μmol/L),P＜0.05. There isno difference between the normal pregnancies with(4.34±1.81μmol/L)and without(4.39±1.55μmol/L) fetal distress group, P＞0.05.2,significant difference is found in the endotheliocytes of umbilicalvein in ICP. The ratio of the appearance of pathological changes in ICPwith fetal distress group(96%) is higher than ICP without fetal distressgroup(76%). The occurrence of the pathological changes is associatedwith TBA.3,The express of eNOS in ICP with fetal distress group (0.09±0.06)is lower than in ICP without fetal distress group(0.21±0.08), P＜0.05. ICPwithout fetal distress group is lower than control group (0.47±0.07), P＜0.05. There is no difference in the group of preggancies with fetaldistress (0.50±0.06)and control group, P＞0.05.On contrast, the express ofET-1 in ICP with fetal distress group (0.49±0.08) is higher than in ICPwithout fetal distress group (0.32±0.07), P＜0.05. ICP without fetaldistress group is higher than control group (0.14±0.06), P＜0.05. There isno difference in the group of preggancies with fetal distress (0.50±0.06)and control group, P＞0.05. The express of iNOS in ICP group with fetaldistress (0.20±0.04) and ICP without fetal distress group (0.21±0.05) islower than in control group (0.26±0.04), P＜0.05, but no significantdifference is found in ICP with fetal distress group and ICP without fetaldistress group, P＞0.05, also no difference is found in control group andthe group of preggancies with fetal distress, P＞0.05.4,The express of eNOS , iNOS and ET-1 is correlate with umbilicalvein TBA in ICP, the coefficient of correlation is r1=-0.88, r2=-0.45r3=0.79, P＜0.01, relatively.5,The level of NO₂^- in ICP with fetal distress group, ICP withoutfetal distress group, control group, and group of normal preggancies withfetal distress is 1.35±0.46μmol/L,2.65±0.36μmol/L,4.24±0.46μmol/L,4.38±0.40μmol/L. ICP with fetal distress group is lower than ICP withoutfetal distress group, P＜0.05. ICP without fetal distress group is lower thancontrol group, P＜0.05. no significant difference is found in the group ofpregganeies with fetal distress and control group,P＞0.05. The level ofET-1 in ICP with fetal distress group, ICP without fetal distress group,control group, and group of normal preggancies with fetal distress is:65.16±2.35pg/ml,58.77±1.15pg/ml,34.91±2.18pg/ml, 34.07±1.22pg/ml.ICP with fetal distress group is higher than ICP without fetal distress group,P＜0.05, ICP without fetal distress group is higher than control group, P＜0.05, no significant difference is found in the group of normalpreggancies with fetal distress and control group, P＞0.05. The ratio ofNO₂^-/ET-1 in umbilical vein in four group is: 0.031±0.007,0.046±0.005,0.124±0.018,0.121±0.006. ICP with fetal distress group is lower than ICPwithout fetal distress group, P＜0.05. ICP without fetal distress group islower than control group, P＜0.05, no significant difference is found in thegroup of normal preggancies with fetal distress and control group,P＞0.05.Conclusion High level of TBA in ICP injures the umbilical veinendothelium, the active compound of endothelium derived relaxing factorand endothelium constracting factor is disbalance in ICP. The expressionof ET-1 is raised,and the synthetase of NO-eNOS, iNOS is downregulation. So we conclude that the pathology change of umbilical veindisbalance is out of control in ICP, it may lead to the spasmo-constractionof umbilical vein endothelium and the disbanance of constraction-relaxation function may be one cause of fetal distress in ICP.